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HomeGrown Solution: Triage Tabletop Simulation

Title

Triage Tabletop Simulation

Submitted by

Laura Liggett, Brandi Snow, Carolina Tennyson

Identification of the Problem

The National Organization of Nurse Practitioner Faculties Nurse Practitioner Core Competencies and the American Association of Colleges of Nursing 2021 Essentials address the need for nurse practitioners to have the knowledge, skills, and attitudes to be clinical leaders while addressing person-centered care through interprofessional collaboration. Simulation-enhanced education is an evidence-based way to evaluate student learning formatively; however, not all universities have the resources like a simulation center.

Unique Idea

You don’t need an expensive, high-fidelity simulation center to teach Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) students about hospital triage, time management, and the role of the nurse practitioner. Our idea describes an accessible simulation modality to further develop clinical decision-making skills through prioritization and transition to practice by understanding the role of the hospitalist nurse practitioner and promoting interprofessional communication.

Objectives

  • Apply clinical knowledge and evidence-based practice guidelines to prioritize rounding and interventions for patients in the acute care setting.
  • Emphasize effective communication strategies with nursing staff to improve patient outcomes and foster a collaborative and respectful culture.
  • Explore the role of the adult-gerontology acute care nurse practitioner in system-wide strategies to improve patient flow, outcomes, and fiscal impact.

Supplies/Ingredients

  • Space: A virtual platform, classroom, or clinical lab that can break into smaller groups.
  • Faculty: Oversee the prebrief, facilitate communication during the simulation via pager, and guide the students during the debrief.
  • Printed Materials: Create a patient rounding list with clinical information pertinent to that patient, including room number, patient initials, age, brief HPI, primary diagnosis, secondary diagnosis, and code status, with a list of times of interdisciplinary rounds the NP has to attend while rounding. Additional sheet to take notes to describe prioritization, reasoning, and task list creation for each patient. (Table #1)
  • Physical Material: A pager or device to send "pages" or messages to the NP with needs from the bedside nurse. An actual phone number could be considered to facilitate a two-way conversation between the NP and the "bedside nurse," played by a faculty member.
  • Diagnostic Results: If students request an EKG, have one on hand for them to interpret. The same goes for chest X-rays or labs, which adds realism.

Steps to Creating the Solution

Simulation Flow:

1. Prebrief:

  • A large group of students will meet in one area where they receive a pre-brief on the scenario, “It is 7:45 am, and you arrived at the hospital for your day shift on the hospitalist services. You receive the below patient list and sign out." You will have 20 minutes in your smaller group to apply clinical knowledge and evidence-based practice guidelines to determine the optimal order of rounding and interventions for patients in the acute care setting, Analyze the importance of effective communication strategies with nursing staff to improve patient outcomes and fostering a collaborative relationship to promote a culture of mutual respect; Explore the impact of the AG-ACNP's role in the system-wide strategy to improve patient flow/outcomes and impact. Thus, within your group, decide in which order you will see your eight patients. Describe your prioritization and reasoning using the attached grid; review and respond to pages from the bedside nurse; communicate with the interprofessional team; develop a task list for each patient; and discuss organization strategies.
  • The large group was divided into smaller groups, with one student delegated as the scribe and another student presenting the material during the debrief.
  • The smaller groups were taken to separate areas to discuss the prioritization of care among each other. At this time, they were provided with printed materials and a pager.

2. Simulation:

  • Patient rounding list of eight patients with interdisciplinary rounds at 10:00 and 10:30. (Table #2)
    • Patient admitted for asthma exacerbation awaiting walking desaturation study and then discharge home today.
    • Patient admitted yesterday was found to have STEMI and underwent emergent cardiac catheterization with elevated blood pressure.
    • A patient admitted 5 days ago for lower extremity gangrene and osteomyelitis with diabetes is NPO waiting to go to the OR.
    • A patient in the emergency department (ED) waiting for admission orders for anemia is getting a blood transfusion in the ED with an elevated heart rate and low normotensive blood pressure reading.
    • A patient admitted with septic shock, acute respiratory failure due to COVID-19, and viral pneumonia is now being managed by hospital medicine under an inpatient hospice with grossly abnormal vital signs.
    • A patient in the intensive care unit (ICU) is awaiting a transfer order to hospital medicine after their four-day admission for acute respiratory failure due to aspiration pneumonia.
    • A patient admitted for urinary traction infection due to urinary retention is awaiting urine cultures sensitivity and then discharged home.
    • A patient was admitted to the observation unit for right lower extremity cellulitis with stable vital signs and an ultrasound negative for deep vein thrombosis.
  • Faculty sent pages from the bedside nurses with the patients' needs every 5 minutes. These pages included issues like elevated blood pressure, hyperglycemia requiring more insulin, electrolytes needing replenishment, and changes in the patient’s mental status. (Table #3)

3. Debriefing:

  • Students returned to the large area as a large group to discuss their decision-making process and reflect on their approach to prioritization.
  • Faculty described one process of prioritizing patient care. They discussed indirect and direct patient care, collaborating with interdisciplinary teams, acting as a mentor to other staff, and how the AG-ACNP documentation shows value in a health system. They described some examples of the healthcare system’s metrics, such as the reduction of 30-day readmissions, discharges from the hospital at a specific time, and, finally, what a typical day of a hospitalist NP is.

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